CPT Insights

Practice Intel:

CPT Insights

One of the most powerful tools available on our platform is CPT Insights. With the help of AI, we analyze the text written for each intervention and assess whether the correct CPT code has been used.

To achieve the highest level of accuracy, we have gone through numerous rounds of human data labeling and AI model training to teach our AI models the definition of each CPT code. 

Our goal with CPT Insights is to provide visibility into the therapists' ability to code interventions correctly. 

CPT Insights offers an in-depth analysis of the four most frequently billed CPT codes:

1. Therapeutic Exercise (97110)

2. Therapeutic Activity (97530)

3. Neuromuscular Re-education (97112)

4. Manual Therapy (97140)

The analysis begins with the starting CPT code and our model predicts whether it is correct or if another code could have been used. This feature allows our clients to identify revenue-enhancing opportunities as well as potential compliance risks.

It is worth mentioning that our model has been trained to be more proactive in its predictions. This means that it may suggest alternative codes in order to bring attention to potential issues and facilitate education for therapists.  However, it is crucial to understand that these suggestions require human review and validation.

Many interventions can be billed as different CPT codes depending on the clinical intent of the intervention performed by the therapist. If there is not adequate justification for an intervention that is coded to a higher value code, our model may predict that it should have been coded as a lower value code. In these instances, it is important to educate therapists on the necessity of documenting the intention behind why a higher value code was selected. 

Example:

Suppose a therapist documents the intervention "Rows RTB 2x15" and assigns the CPT code for Therapeutic Exercise (97110). Our model may suggest that this could alternatively have been coded as Neuromuscular Re-education (97112). The rationale for this suggestion is that rows are commonly used to aid with posture, and any posture-related exercise could potentially be coded under Neuromuscular Re-education. While this intervention may require more justification to be coded as Neuromuscular Re-education, we want our users to be aware of such possibilities. This way, therapists can understand which specific activities performed could be coded differently

As an ongoing process, we continue to validate and re-train our models with human validation. It is important to acknowledge that no AI technology can achieve perfection. Therefore at times, you may disagree with the AI’s assessment. To help improve the models, we have given users the ability to give feedback on the models’ predictions within the interface. Your feedback will help our model get smarter as it makes coding predictions: 

By utilizing CPT Insights, practice owners can help therapists enhance their coding accuracy. However, it is important to remember that the code selected should reflect the clinical intent of the therapist performing the intervention.  This tool is meant only to act as a guide to help identify where there may be opportunities for coding improvement. 

If you have any questions about CPT Insights, please reach out to ptsupport@predictionhealth.com.